Fentanyl Addiction, Health Effects, & Recovery
What Is Fentanyl?
Fentanyl is a powerful synthetic opioid analgesic sometimes prescribed to treat severe pain.2
Pharmaceutical fentanyl is intended for hospital or other prescription use; however fentanyl—like other prescription painkillers—is also produced illegally in clandestine labs and misused for its ability to quickly induce feelings of pleasure or excitement and intense happiness and well-being.”2 Illicit drug manufacturers and dealers are increasingly combining fentanyl with other drugs purchased on the streets, such as heroin, cocaine, meth, MDMA, or counterfeit prescription pills (e.g., Xanax, oxycodone, etc.), which may cause accidental overdose for those who purchase and use these drugs.2,4
Pharmaceutical fentanyl may be administered via several different routes (e.g., oral, transdermal patch, injection, sublingual spray) and is available under several different brand names, including:2, 4,5,6
Fentanyl is more potent than most other opioids used for pain control and is much stronger than morphine and even heroin, which is one reason it carries such a high risk of overdose.4 Fentanyl is around 100 times more potent than morphine and 50x more potent than heroin.4
The Drug Enforcement Administration (DEA) lists fentanyl as a Schedule II controlled substance, indicating it has legitimate medical uses but also a high potential for abuse and dependence.7
How Does Fentanyl Work?
Fentanyl is a synthetic, fast-acting opioid agonist. By binding to and activating opioid receptors in the body, fentanyl quickly and effectively reduces or eliminates feelings of severe pain, such as that associated with surgery or major trauma. It may also, particularly when misused, cause a euphoric high.2
Side Effects & Health Risks of Fentanyl
There are a number of potential side effects associated with fentanyl use. Reported side effects include:2,4,5,6
- Dry mouth.
- Mood changes (e.g., anxiety, depression).
- Urinary changes.
- Loss of appetite and weight loss.
- Irregular heartbeat.
- Slowed breathing.
- Loss of consciousness.
Signs of a fentanyl overdose may include:2-6,8
- Severely slowed, or stopped, breathing.
- Pinpoint pupils.
- Limp muscles.
- Severe drowsiness or inability to be awakened (i.e., loss of consciousness).
- Slowed heartbeat and low blood pressure.
- Cold and clammy skin which may have a blue tint or pale color.
How Is Fentanyl Abused?
Pharmaceutical fentanyl—such as transdermal fentanyl patches, sublingual spray, and troche/lozenge/lollipops—is sometimes diverted for illicit or nonmedical use. People who misuse pharmaceutical fentanyl may attempt to extract the drug out of the patch and either inject or orally consume it, whereas lozenge and lollipop forms may be crushed or chewed to bypass the intended extended-release mechanisms prior to being consumed. 2,4,5
While prescription fentanyl is sometimes misused or diverted for illicit use, much of the fentanyl sold on the streets is manufactured illegally. Illicitly manufactured fentanyl (IMF) can be snorted, injected, smoked, or swallowed and may be present in other drugs sold illegally, including heroin. Fentanyl is often sold in a powder form but may also be dropped on blotter paper, administered via an eyedropper or nasal spray. 2,4,5
Is Fentanyl Addictive?
Like all opioids, fentanyl has a high abuse liability and may result in dependence which can lead to addiction. Fentanyl and other opioids can also elicit a rewarding euphoric high that may prompt repeated use. Over time, a person may begin to prioritize using fentanyl or other opioids over important aspects of life (family, job, school) and may continue to use it despite experiencing negative consequences. This is the hallmark of addiction and is indicative of a likely opioid use disorder.2, 12
How Does Opioid Addiction Start?
It is not unusual for anyone who uses fentanyl or another opioid the drug for even a short period of time to develop a tolerance (needing more of the drug to feel its effects) and dependence (needing the drug to avoid withdrawal) to fentanyl, or any opioid.2 Though a dependence to fentanyl is not the same thing as being addicted to it, dependence (and avoidance of the accompanying acute opioid withdrawal syndrome) may contribute to a person’s compulsive misuse of the drug which may lead to addiction.13
Potential for abuse and risks of addiction and overdose are always present with opioids. Addiction may occur with both prescription and illicit use of fentanyl.14
Opioids and other drugs of abuse also affect the motivation and reward centers of the brain, causing lasting changes that may lead someone to continue using them despite the harm they cause.12
Signs of Fentanyl Addiction
While only a treatment professional may diagnose an opioid use disorder (OUD), it is helpful to understand the criteria they look at when making a diagnosis. OUD diagnostic criteria include:13
- Spending a great deal of time trying to get, use, or recover from opioids.
- Desiring to decrease opioid use but not succeeding in attempts to cut back or stop.
- Taking opioids in larger amounts or over a longer period of time than intended.
- Strong cravings or urges for continued fentanyl use.
- Use of opioids leads to the inability to fulfill important obligations.
- Using opioids in situations that can cause significant physical danger, such as before operating machinery.
- Continuing to use opioids in spite of negative repercussions socially, academically, or at work.
- Giving up activities that were once important to use opioids.
- Continuing to use opioids despite knowledge that it is causing physical or mental harm.
- Needing to keep increasing doses to get the desired effects.
- Needing to take opioids to avoid withdrawal symptoms.
Opioid addiction can be a devastating condition; however, effective evidence-based treatment is available.12 Treatment may vary greatly from one person to another in terms of the appropriate setting, length of stay, use of medications, etc., but treatment for opioid addiction typically involves medical detox, followed by rehabilitation, then developing and following an aftercare plan.12
Treatment for opioid use disorder (OUD) is covered by most insurance plans, though the options available and level of coverage may vary. You may check your benefits for rehab with our .
Fentanyl withdrawal—while rarely life-threatening—can be so unpleasant it may lead someone to relapse.15 Relapse is perhaps the most dangerous complication of opioid withdrawal. A person’s tolerance to opioids is built up after regular long-term use and it decreases substantially during detox. Returning to opioid use with a lowered tolerance increases the risk of a fatal overdose.
Many people seeking to end their compulsive fentanyl or other opioid use do so under the safety and supervision of a physician in a professional medical detox program. With medical detox, medical staff can administer medication to ease cravings and withdrawal symptoms, while monitoring the patient’s condition and responding to any complications.15 It may also help stave off a return to opioid use and potential overdose. Some common fentanyl withdrawal symptoms include:2
- Body aches.
- Anxiety and depression.
- Craving for opioids.
During withdrawal management, people are often first stabilized with other opioid agonists like buprenorphine or methadone that do not elicit the same euphoric “high” associated with other opioids yet ease fentanyl withdrawal symptoms and cravings. In some cases, a tapering schedule of the replacement medication is initiated to slowly ease individuals off the drug over a scheduled period of time; while others may need to be safely maintained on medication during and after rehab.15,16,17
Inpatient & Outpatient Rehab for Fentanyl Abuse
Medical detox alone is typically not sufficient treatment for sustained recovery for those with an opioid use disorder. It is often a necessary first step that’s followed by formal drug rehab, where people struggling with opioid addiction address the underlying issues that led to their compulsive drug use in the first place. Both medications and behavioral therapy are effective treatment components and can help prevent a return to illicit drug use and reduce the risk of relapse as well as the risk of fatal overdose.12,15
- Cognitive-behavioral therapy (CBT).
- Motivational interviewing.
- Contingency management.
- Group counseling.
- Medication-assisted treatment (MAT).
It’s imperative to choose a treatment program that caters care to an individual’s needs. There are various settings in which rehabilitation can be performed; the right option depends on the patient’s individual needs. Treatment progress should be evaluated and the treatment plan adjusted as needed throughout the recovery process.12
Continuing care—also called aftercare—is another important aspect of treatment for many people recovering from opioid addiction. Aftercare options can range from staying at a sober living facility to simply attending weekly meetings with a peer support group. Recovery is a lifelong process, and maintaining a positive network that is conducive to sobriety is crucial.19